Severe Fatigue in Palliative Treatment of Cancer
Severe Fatigue in Palliative Treatment of Cancer
A total of 208 patients with noncurable advanced cancer were identified by the investigator (M.E.W.J.P.). Eight patients were not considered eligible by their physician. The remaining 200 patients were invited to participate in the study, and 162 patients (81%) agreed to participate. Study questionnaires were returned by 137 (85%) of 162 participating patients. Only 3 participants preferred to complete study questionnaires on a computer; all others used the paper-and-pencil version. Reasons given for not returning the questionnaires (n = 25) were that completing the questionnaires was too strenuous or the questions were too confronting (n = 12). Four patients did not give a specific reason but did not want to participate anymore, and 7 patients did not return the questionnaires despite repeated reminders. Two patients died unexpectedly.
Not all questionnaires were completed by all patients. The Checklist Individual Strength was completed by 136 patients, the EORTC-QLQ-C30 by 122 patients, and the McGill Pain Questionnaire by 135 patients. Hemoglobin levels were available for all 137 patients.
Of the 137 participants, the mean age was 59 years (range, 30–79 years), and 53 patients (39%) were male ( Table 1 ). Most patients were married (81%). Table 1 also shows some characteristics of the group patients who did not participate in this study. Of these 71 patients, the mean age was 60 years (range, 22–86 years), and 29 of them (41%) were male. Nonparticipants and participants did not differ in age (P = .656) or gender (P = .767).
The majority of the participants had breast cancer or gastrointestinal cancer (both 30%); nonparticipants had a prevalence of 24% of both breast and gastrointestinal cancers. The distribution of cancer type did not differ significantly between the 2 groups (P = .476).
The primary treatment represented was chemotherapy (68%), in combination (with radiotherapy or targeted therapy) or as single modality therapy. At the time the participants completed the study questionnaires, 90 (67%) were receiving their first line of treatment in the palliative phase, 28 patients (20%) their second line of treatment, 12 patients (9%) their third line, and 5 patients (4%) were receiving a fourth line of treatment. Two patients completed the questionnaires just before starting their first-line palliative treatment.
Severe fatigue was present in 47% of all participating patients (Table 1). Age did not significantly differ between severely fatigued (mean age, 58.7 years [SD, 9.9] years) and not severely fatigued patients (mean age, 58.9 [SD, 10.1] years) (P = .851), but there was a significant difference in fatigue severity between genders; 55% of the women were severely fatigued compared with 35% of the men (P < .05). When we excluded participants with breast and gynecologic cancers, 50% of the women (n = 30) were severely fatigued, and the difference between men and women was no longer significant (P = .175).
Of the 92 participants who received first line of treatment, 40% were severely fatigued. This percentage was higher (60%) in patients who received further lines of treatment. This difference was significant (P < .05) (Table 1). There were no significant differences between cancer types in the occurrence of severe fatigue or between various treatment modalities, even when various treatment modalities were combined. In particular, no difference was found in severe fatigue between participants treated with chemotherapy, as monotherapy or combination therapy (51%), compared with participants not receiving chemotherapy but receiving radiotherapy, hormonal treatment, or oral targeted therapy (42%) (P = .347).
Participants with severe fatigue scored significantly higher than non–severely fatigued patients on dyspnea, pain, appetite loss, nausea and vomiting, and constipation ( Table 2 ).
Mean visual analog scale pain scores of the McGill Pain Questionnaire did not significantly differ between severely and non–severely fatigued participants on the 3 outcomes of the McGill Pain Questionnaire: pain at this actual moment, when pain was at its most, and when pain was at its least. No significant difference was found in Hb levels (median, 7.9 mmol/L) between severely and non–severely fatigued patients. Of note, only 6 participants were anemic at the time the questionnaires were completed.
Results
A total of 208 patients with noncurable advanced cancer were identified by the investigator (M.E.W.J.P.). Eight patients were not considered eligible by their physician. The remaining 200 patients were invited to participate in the study, and 162 patients (81%) agreed to participate. Study questionnaires were returned by 137 (85%) of 162 participating patients. Only 3 participants preferred to complete study questionnaires on a computer; all others used the paper-and-pencil version. Reasons given for not returning the questionnaires (n = 25) were that completing the questionnaires was too strenuous or the questions were too confronting (n = 12). Four patients did not give a specific reason but did not want to participate anymore, and 7 patients did not return the questionnaires despite repeated reminders. Two patients died unexpectedly.
Not all questionnaires were completed by all patients. The Checklist Individual Strength was completed by 136 patients, the EORTC-QLQ-C30 by 122 patients, and the McGill Pain Questionnaire by 135 patients. Hemoglobin levels were available for all 137 patients.
Patient Characteristics
Of the 137 participants, the mean age was 59 years (range, 30–79 years), and 53 patients (39%) were male ( Table 1 ). Most patients were married (81%). Table 1 also shows some characteristics of the group patients who did not participate in this study. Of these 71 patients, the mean age was 60 years (range, 22–86 years), and 29 of them (41%) were male. Nonparticipants and participants did not differ in age (P = .656) or gender (P = .767).
The majority of the participants had breast cancer or gastrointestinal cancer (both 30%); nonparticipants had a prevalence of 24% of both breast and gastrointestinal cancers. The distribution of cancer type did not differ significantly between the 2 groups (P = .476).
The primary treatment represented was chemotherapy (68%), in combination (with radiotherapy or targeted therapy) or as single modality therapy. At the time the participants completed the study questionnaires, 90 (67%) were receiving their first line of treatment in the palliative phase, 28 patients (20%) their second line of treatment, 12 patients (9%) their third line, and 5 patients (4%) were receiving a fourth line of treatment. Two patients completed the questionnaires just before starting their first-line palliative treatment.
Occurrence of Severe Fatigue
Severe fatigue was present in 47% of all participating patients (Table 1). Age did not significantly differ between severely fatigued (mean age, 58.7 years [SD, 9.9] years) and not severely fatigued patients (mean age, 58.9 [SD, 10.1] years) (P = .851), but there was a significant difference in fatigue severity between genders; 55% of the women were severely fatigued compared with 35% of the men (P < .05). When we excluded participants with breast and gynecologic cancers, 50% of the women (n = 30) were severely fatigued, and the difference between men and women was no longer significant (P = .175).
Severe Fatigue in Different Treatment Lines, Various Cancers, and Treatment Modalities
Of the 92 participants who received first line of treatment, 40% were severely fatigued. This percentage was higher (60%) in patients who received further lines of treatment. This difference was significant (P < .05) (Table 1). There were no significant differences between cancer types in the occurrence of severe fatigue or between various treatment modalities, even when various treatment modalities were combined. In particular, no difference was found in severe fatigue between participants treated with chemotherapy, as monotherapy or combination therapy (51%), compared with participants not receiving chemotherapy but receiving radiotherapy, hormonal treatment, or oral targeted therapy (42%) (P = .347).
Do Severely Fatigued Cancer Patients Have More Cancer-related Symptoms?
Participants with severe fatigue scored significantly higher than non–severely fatigued patients on dyspnea, pain, appetite loss, nausea and vomiting, and constipation ( Table 2 ).
Mean visual analog scale pain scores of the McGill Pain Questionnaire did not significantly differ between severely and non–severely fatigued participants on the 3 outcomes of the McGill Pain Questionnaire: pain at this actual moment, when pain was at its most, and when pain was at its least. No significant difference was found in Hb levels (median, 7.9 mmol/L) between severely and non–severely fatigued patients. Of note, only 6 participants were anemic at the time the questionnaires were completed.